Poster presented at AORN's 58th Annual Congress: CMS requires that, for certain procedures, perioperative areas administer the majority of prophylactic antibiotics within a specified timeframe (60 minutes), which has been shown to reduce surgical site infections. We identified improvement opportunities in this arena, and created a multidisciplinary team to reduce the time between delivery of prophylactic antibiotics and incision. The team created rapid cycle interventions and also provided direct feedback to surgical leadership on performance data. The process showed substantial improvement between first quarter 2009 (85% compliance) and the first two months of 2010 (93% compliance), with two specialties (neurosurgery and cardiovascular) achieving 100% compliance. Objective #1 Review CMS guidelines regarding perioperative prophylactic antibiotic delivery times. Objective #2 Describe different interventions used to improve perioperative delivery times. Objective #3 Emphasize a team-based approach to improving key processes. Introduction: The literature has suggested a correlation between ideal antibiotic delivery times for surgery and a diminished rate of surgical site infections in both adult and pediatric patients. CMS now requires that, for certain procedures, perioperative areas administer the majority of prophylactic antibiotics within a specified timeframe (60 minutes). Initiative Description: Evaluating the process of getting delivery times to an acceptable level is crucial to help achieve ideal patient outcomes. In 2009, our hospital reviewed an opportunity for improvement in the perioperative area, focusing on the delivery time of prophylactic antibiotics for all indicated procedures. A multidisciplinary team was created, consisting of key surgeons and anesthesiologists, operating room nurses, infection control, quality improvement consultants, and other perioperative personnel. The team members reviewed all records where antibiotics were delivered and sought opportunities to improve compliance of delivery within the specified time frame, which was 60 minutes prior to incision for most prophylactic antibiotics (120 minutes for Vancomycin and quinolones). Specific interventions for which PDSA cycles were created included the coordination of times on all clocks within the operating room (wall clock, anesthesia monitor, and the circulating nurses computer), the timing of the surgical skin prep, and direct feedback to surgeons. Results: As a result of this initiative, the rate of overall perioperative service compliance with prophylactic antibiotic delivery improved from 85% in quarter one of 2009 to 93% in the first two months of 2010 for all service lines. The services with the largest opportunity for improvement to achieve the 60-minute window were the cardiovascular (CV), neurosurgery (NS), and the oral-maxillofacial surgery (OMS) services. The CV compliance improved from 85% to 100%, the NS compliance improved from 83% to 100%, and the OMS compliance improved from 40% to 65% in early 2010. Lessons Learned: As with many hospital improvement projects, a team-based approach utilizing a top-down with a bottom-up method is critical to success. Simple interventions, such as synchronization of clocks within the operating room, are easy to implement and can have a major effect on accuracy. Monitoring of data with direct individualized feedback data to surgery leadership can motivate the need for change.

This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Poster presented at AORN's 58th Annual Congress: CMS requires that, for certain procedures, perioperative areas administer the majority of prophylactic antibiotics within a specified timeframe (60 minutes), which has been shown to reduce surgical site infections. We identified improvement opportunities in this arena, and created a multidisciplinary team to reduce the time between delivery of prophylactic antibiotics and incision. The team created rapid cycle interventions and also provided direct feedback to surgical leadership on performance data. The process showed substantial improvement between first quarter 2009 (85% compliance) and the first two months of 2010 (93% compliance), with two specialties (neurosurgery and cardiovascular) achieving 100% compliance. Objective #1 Review CMS guidelines regarding perioperative prophylactic antibiotic delivery times. Objective #2 Describe different interventions used to improve perioperative delivery times. Objective #3 Emphasize a team-based approach to improving key processes. Introduction: The literature has suggested a correlation between ideal antibiotic delivery times for surgery and a diminished rate of surgical site infections in both adult and pediatric patients. CMS now requires that, for certain procedures, perioperative areas administer the majority of prophylactic antibiotics within a specified timeframe (60 minutes). Initiative Description: Evaluating the process of getting delivery times to an acceptable level is crucial to help achieve ideal patient outcomes. In 2009, our hospital reviewed an opportunity for improvement in the perioperative area, focusing on the delivery time of prophylactic antibiotics for all indicated procedures. A multidisciplinary team was created, consisting of key surgeons and anesthesiologists, operating room nurses, infection control, quality improvement consultants, and other perioperative personnel. The team members reviewed all records where antibiotics were delivered and sought opportunities to improve compliance of delivery within the specified time frame, which was 60 minutes prior to incision for most prophylactic antibiotics (120 minutes for Vancomycin and quinolones). Specific interventions for which PDSA cycles were created included the coordination of times on all clocks within the operating room (wall clock, anesthesia monitor, and the circulating nurses computer), the timing of the surgical skin prep, and direct feedback to surgeons. Results: As a result of this initiative, the rate of overall perioperative service compliance with prophylactic antibiotic delivery improved from 85% in quarter one of 2009 to 93% in the first two months of 2010 for all service lines. The services with the largest opportunity for improvement to achieve the 60-minute window were the cardiovascular (CV), neurosurgery (NS), and the oral-maxillofacial surgery (OMS) services. The CV compliance improved from 85% to 100%, the NS compliance improved from 83% to 100%, and the OMS compliance improved from 40% to 65% in early 2010. Lessons Learned: As with many hospital improvement projects, a team-based approach utilizing a top-down with a bottom-up method is critical to success. Simple interventions, such as synchronization of clocks within the operating room, are easy to implement and can have a major effect on accuracy. Monitoring of data with direct individualized feedback data to surgery leadership can motivate the need for change.

This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

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